Kuyini iRestenosis?

-Delile

• Ukubuka konke
• I-in-stent restenosis (ISR)
• Izimpawu ze-restenosis
• Izimbangela ze-restenosis
• Umugqa wesikhathi we-restenosis ozokwenzeka
• Ukuxilongwa kwe-restenosis
• Ukwelashwa kwe-restenosis
• Ukubukwa nokuvinjelwa kwe-restenosis

Ukubuka konke

I-stenosis ibhekisa ekunciphiseni noma ekuvaleni umthambo ngenxa yokwakheka kwento enamafutha ebizwa nge-plaque (atherosclerosis). Uma kwenzeka emithanjeni yenhliziyo (i-coronary arteries), ibizwa nge-coronary artery stenosis.

I-Restenosis (“re” + “stenosis”) yilapho ingxenye yomthambo owawukade welashwa ukuvinjelwa iphinda iba mincane futhi.

I-in-stent restenosis (ISR)

I-Angioplasty, uhlobo lwe-percutaneous coronary intervention (PCI), inqubo esetshenziselwa ukuvula imithambo evinjiwe. Ngesikhathi kwenziwa le nqubo, isikafula esincane sensimbi, esibizwa ngokuthi i-cardi stent, cishe ngaso sonke isikhathi sifakwa emthanjeni lapho savulwa khona futhi. I-stent isiza ukugcina umthambo uvulekile.

Lapho ingxenye yomthambo ene-stent ivinjelwa, ibizwa nge-in-stent restenosis (ISR).

Lapho i-clot yegazi, noma i-thrombus, iba yingxenye yomthambo one-stent, ibizwa nge-in-stent thrombosis (IST).

Izimpawu ze-restenosis

I-Restenosis, noma ingenayo i-stent, yenzeka kancane kancane. Ngeke kubangele izimpawu kuze kube yilapho ukuvinjelwa kubi ngokwanele ukugcina inhliziyo ingatholi inani eliphansi legazi eliyidingayo.

Lapho izimpawu zikhula, ngokuvamile zifana kakhulu nezimpawu ukuvinjelwa kwasekuqaleni okudalwe ngaphambi kokuba kulungiswe. Ngokuvamile lezi izimpawu zesifo senhliziyo (i-CAD), njengobuhlungu besifuba (i-angina) nokuphefumula okuncane.

I-IST ivame ukudala izimpawu ezingazelelwe nezinzima. Ihlwili livame ukuvimba wonke umthambo we-coronary, ngakho-ke alikho igazi elingafika engxenyeni yenhliziyo eliyiphakelayo, libangele isifo senhliziyo (i-myocardial infarction).

Ngaphezu kwezimpawu zesifo senhliziyo, kungahle kube nezimpawu zezinkinga njengokuhluleka kwenhliziyo.

Izimbangela ze-restenosis

I-Balloon angioplasty inqubo esetshenziselwa ukwelapha i-coronary stenosis. Kubandakanya ukufaka intambo ngepayipi engxenyeni encishisiwe yomthambo we-coronary. Ukunweba ibhaluni ethiphu le-catheter kududulela uqwembe eceleni, kuvule umthambo.

Inqubo ilimaza izindonga zomthambo. Izicubu ezintsha zikhula odongeni olimele njengoba umthambo uphola. Ekugcineni, ulwelwesi olusha lwamaseli aphilile, abizwa nge-endothelium, lumboza isiza.

I-Restenosis yenzeka ngoba izindonga zomthambo onwebekayo zivame ukubuyela emuva kancane ngemuva kokwelulwa zivulekile. Futhi, umthambo uyancipha uma ukukhula kwezicubu ngesikhathi sokuphulukiswa kudlulele.

I-Bare metal stents (BMS) yathuthukiswa ukusiza ukumelana nokuthambekela komthambo ovulwe kabusha wokuvala ngenkathi kusalulama.

I-BMS ibekwa ngasodongeni lomthambo lapho ibhaluni ligcwala ngesikhathi se-angioplasty. Kuvimbela izindonga ukuthi zingabuyeli emuva, kepha ukukhula okusha kwezicubu kwenzeka ekuphenduleni ukulimala. Lapho izicubu eziningi zikhula, umthambo uqala ukuncipha, bese kuthi i-restenosis ivele.

Izidakamizwa zokuqothula izidakamizwa (i-DES) manje sezingamasenti asetshenziswa kakhulu. Bayinciphise kakhulu inkinga ye-restenosis, njengoba kubonwe ngamazinga e-restenosis atholakala ku-athikili ka-2009 eshicilelwe ku-American Family Physician:

• ibhaluni angioplasty ngaphandle kwe-stent: amaphesenti angama-40 eziguli athuthukiswe yi-restenosis
• I-BMS: amaphesenti angama-30 athuthukise i-restenosis
• I-DES: ngaphansi kwamaphesenti ayishumi kuthuthukiswe i-restenosis

I-atherosclerosis nayo ingadala i-restenosis. I-DES isiza ukuvimbela i-restenosis ngenxa yokukhula kwezicubu ezintsha, kepha ayithinti isimo esingaphansi esidale ukuqina kwe-stenosis.

Ngaphandle kokuthi izimo zakho zobungozi zishintshe ngemuva kokubekwa kwe-stent, i-plaque izoqhubeka nokwakha emithanjeni yakho ye-coronary, kufaka phakathi ama-stents, angaholela ekuphumuleni.

I-thrombosis, noma i-clot yegazi, ingakheka lapho izinto ezijiyisayo egazini zihlangana nento engajwayelekile emzimbeni, njenge-stent. Ngenhlanhla, ngokusho kwe-IST, ikhula cishe ngamaphesenti ayi-1 kuphela we-coronary artery stents.

Umugqa wesikhathi we-restenosis ozokwenzeka

I-Restenosis, ebekiwe noma engenawo ama-stent, ngokuvamile ibonakala phakathi kwezinyanga ezintathu kuya kweziyisithupha ngemuva kokuba umthambo uvulwe kabusha. Ngemuva konyaka wokuqala, ingozi yokuba ne-restenosis kusuka ekukhuleni kwezicubu ngokweqile incane kakhulu.

I-Restenosis evela ku-CAD eyisisekelo ithatha isikhathi eside ukukhula, futhi imvamisa kwenzeka ngonyaka noma ngaphezulu ngemuva kokuphathwa kwe-stenosis yoqobo. Ubungozi be-restenosis buyaqhubeka kuze kube kunciphisa izinto ezinobungozi zesifo senhliziyo.

Ngokuya nge, ama-ISTs amaningi enzeka ezinyangeni zokuqala ngemuva kokubekwa kwe-stent, kepha kukhona ingozi encane, kepha ebalulekile, ngonyaka wokuqala. Ukuthatha izinciphisi zegazi kunganciphisa ubungozi be-IST.

Ukuxilongwa kwe-restenosis

Uma udokotela wakho esola i-restenosis, ngokujwayelekile bazosebenzisa olunye lwezivivinyo ezintathu. Lezi zivivinyo zisiza ukuthola ulwazi mayelana nendawo, usayizi, nezinye izici zokuvinjelwa. Kunjalo:

• I-angiogram yeCoronary. Idayi ijojowe emthanjeni ukuze iveze ukuvinjelwa futhi ikhombise ukuthi igazi lihamba kahle kanjani kwi-X-ray.
• I-ultrasound yemithambo yegazi. Amagagasi omsindo akhishwa ku-catheter ukudala isithombe sengaphakathi lomthambo.
• Ukubumbana kokubumbana kwe-Optical. Amagagasi okukhanya akhishwa epayipini ukuze akhe izithombe ezinokucaca okuphezulu kwengaphakathi lomthambo.

Ukwelashwa kwe-restenosis

I-Restenosis engabangeli izimpawu ngokuvamile ayidingi ukwelashwa.

Lapho kuvela izimpawu, zivame ukuba zimbi kancane kancane, ngakho-ke kunesikhathi sokwelapha i-restenosis ngaphambi kokuba umthambo uvale ngokuphelele futhi ubangele isifo senhliziyo.

I-Restenosis emthanjeni ngaphandle kwe-stent ivame ukuphathwa nge-balloon angioplasty nokubekwa kwe-DES.

I-ISR ivame ukuphathwa ngokufakwa kwesinye istent (imvamisa i-DES) noma i-angioplasty kusetshenziswa ibhaluni. Ibhaluni ligcotshwe ngemithi esetshenziswa ku-DES ukuvimbela ukukhula kwezicubu.

Uma i-restenosis iqhubeka nokwenzeka, udokotela wakho angacabanga ngokuhlinzwa kwe-artery coronary bypass (CABG) ukugwema ukubeka ama-stents amaningi.

Kwesinye isikhathi, uma ukhetha ukungabi nenqubo noma ukuhlinzwa noma ubungeke ukubekezelele kahle, izimpawu zakho zizokwelashwa ngemithi kuphela.

I-IST cishe ngaso sonke isikhathi iyisimo esiphuthumayo. Kuze kube ngamaphesenti angama-40 abantu abane-IST abangasindi kuyo. Ngokuya ngezimpawu, kuqala ukwelashwa i-angina engazinzile noma isifo senhliziyo. Imvamisa i-PCI yenziwa ukuzama ukuvula umthambo ngokushesha okukhulu nokunciphisa ukulimala kwenhliziyo.

Kungcono kakhulu ukuvimbela i-IST kunokuzama ukuyelapha. Yingakho, kanye ne-aspirin yansuku zonke yokuphila, ungathola ezinye izinciphisi zegazi, njenge-clopidogrel (Plavix), i-prasugrel (i-Effient), noma i-ticagrelor (i-Brilinta).

Lezi zinciphisi zegazi ngokuvamile zithathwa isikhathi esingangenyanga eyodwa, kepha imvamisa unyaka owodwa noma ngaphezulu, ngemuva kokubekwa kwesitofu.

Ukubukwa nokuvinjelwa kwe-restenosis

Ubuchwepheshe bamanje bukwenze kwaba nethuba elincane kakhulu lokuthi uzoba ne-restenosis kusuka ekukhuleni kwezicubu ngemuva kwe-angioplasty noma ukubekwa kwe-stent.

Ukubuya kancane kancane kwezimpawu obukade unazo ngaphambi kokuvaleka kokuqala emthanjeni kuwuphawu lokuthi i-restenosis iyenzeka, futhi kufanele ubone udokotela wakho.

Akukho okuningi ongakwenza ukuvimbela i-restenosis ngenxa yokukhula ngokweqile kwezicubu ngesikhathi sokuphulukiswa. Kodwa-ke, ungasiza ukuvimbela i-restenosis ngenxa yesifo somthambo we-coronary.

Zama ukugcina impilo enempilo yenhliziyo ehlanganisa ukungabhemi, ukudla okunempilo nokuvivinya umzimba ngokulingene. Lokhu kunganciphisa ubungozi bokwakhiwa kocwecwe emithanjeni yakho.

Kungenzeka futhi ukuthi ungatholi i-IST, ikakhulukazi ngemuva kokuthi ube ne-stent inyanga eyodwa noma ngaphezulu. Ngokungafani ne-ISR, noma kunjalo, i-IST ivame ukuba yimbi kakhulu futhi ivame ukudala izimpawu ezingazelelwe zokuhlaselwa yisifo senhliziyo.

Yingakho ukuvimbela i-IST ngokuthatha izinciphisi zegazi inqobo nje uma udokotela wakho encoma kubaluleke kakhulu.